Complete Shoulder dystocia in the presence of scarred uterus  is  an  acute  obstetrical emergency and if not properly handled can lead to serious fetal  and maternal complications. A G₅P₄A_O  previous II cesarean sections, presented in emergency  after delivery of fetal head and impacted shoulders,  at a small  private clinic in a village, four hours back. On laparotomy, there was uterine rupture from the previous uterine  scar  along with  posterior  bladder wall  rupture .  The shoulder dystocia was relieved by decapitation and breech extraction abdominally. Subtotal hysterectomy and repair of the bladder wall was done. This case highlight the dilemma of lack of regular antenatal care and maternal education, malpractices by untrained health professionals  and  time  lapse in referral system that is still a very serious and major issue in developing countries like Pakistan .

Keywords:  Shoulder dystocia, obstructed labor, and uterine rupture